title: A comparison of the outcomes of one-stage and two-stage brachiobasilic arteriovenous fistulas.
abstract: OBJECTIVE
  The brachiobasilic arteriovenous fistula (BBAVF) can be formed in one or two stages. This study examined the failure rates and functional patencies of one-stage vs two-stage brachiobasilic transposition fistulas to compare the two surgical techniques.
  
  
  METHODS
  We retrospectively identified all the patients who underwent BBAVF access surgery at King's College Hospital between January 1, 2009, and December 31, 2011 (3 years). Patients were divided into two groups according to one-stage or two-stage procedure. All patients were seen in the access clinic 4 to 6 weeks postoperatively, and their fistulas were scanned (duplex). The surveillance of fistulas consists of duplex scans every 6 months to assess volume flow.
  
  
  RESULTS
  During the study interval, 149 brachiobasilic transpositions (65 one-stage and 84 two-stage) were performed in 141 patients. Patients undergoing the two-stage procedure had a smaller mean preoperative vein diameter (4.0 ± 1.1 vs 3.6 ± 1.3 mm; P = .041) and tended to be older (58 ± 15 vs 63 ± 15 years; P = .062). Mean overall follow-up was 559 ± 333 days. There was no difference in primary failure between the two groups (45% vs 42%; P = .718). At 1 year, the two-stage BBAVFs had significantly better primary (71% vs 87%; P = .034), assisted primary (77% vs 95%; P = .017), and secondary functional (79% vs 95%; P = .026) patencies. The same applied to 2-year primary (53% vs 75%; P = .034), assisted primary (57% vs 77%; P = .017), and secondary functional (57% vs 77%; P = .026) patencies. Multivariate Cox regression showed that the one-stage procedure was 3.2 times more likely to fail (P = .028). Men were 2.7 times more likely to lose their access (P = .054).
  
  
  CONCLUSIONS
  This study describes a large series of BBAVFs and makes an extensive comparison between the one-stage and two-stage operations. Significantly improved overall functional patency is demonstrated for the two-stage operation.
authors.affiliation: Renal Department, King's College Hospital, London, United Kingdom; Department of Nephrology and Transplantation, Guy's Hospital, London, United Kingdom. Electronic address: georgiosvrakas@gmail.com.
authors.forename: Georgios
authors.initials: G
authors.lastname: Vrakas
authors.forename: Fatima
authors.initials: F
authors.lastname: Defigueiredo
authors.forename: Sam
authors.initials: S
authors.lastname: Turner
authors.forename: Chris
authors.initials: C
authors.lastname: Jones
authors.forename: John
authors.initials: J
authors.lastname: Taylor
authors.forename: Francis
authors.initials: F
authors.lastname: Calder
mesh_terms: D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D034941:Upper Extremity / Q000098:blood supply*; D014654:Vascular Patency; D014680:Veins / Q000601:surgery